| Greenwood Gastroenterology Center | |
|
202 W Park Ave Greenwood MS 38930 | |
| (662) 455-8058 | |
| Not Available |
| Full Name | Greenwood Gastroenterology Center |
|---|---|
| Speciality | Internal Medicine |
| Location | 202 W Park Ave, Greenwood, Mississippi |
| Authorized Official Name and Position | Dawne Holmes (CFO) |
| Authorized Official Contact | 6624597119 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greenwood Gastroenterology Center Po Box 1410 Greenwood MS 38935-1410 Ph: (662) 455-8058 | Greenwood Gastroenterology Center 202 W Park Ave Greenwood MS 38930 Ph: (662) 455-8058 |
| NPI Number | 1679802946 |
|---|---|
| Provider Enumeration Date | 12/16/2009 |
| Last Update Date | 07/02/2018 |
| Medicare PECOS PAC ID | 0941332910 |
|---|---|
| Medicare Enrollment ID | O20100712000112 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679802946 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Richard A Goldberg |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1689831844 PECOS PAC ID: 2365688355 Enrollment ID: I20150713001539 |
| Provider Name | Kathryn Flanagan Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528434214 PECOS PAC ID: 4789946377 Enrollment ID: I20180319002513 |
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